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Posted June 17, 2009

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Elderly Behavior: Differentiating Between Dementia and Meanness

Q. I am the caregiver for a patient with dementia. My question is regarding his personality. I am having a hard time knowing when his actions are a result of dementia or his personality. My patient has incontinence problems with his bowels. He will have an accident on the floor and will tell me things like, "Look what you have to clean up," or he will pull off his underpants and throw them in the floor then tell me his bathroom need cleaning. Is this dementia at work or meanness?

Another problem is with his personal hygiene. I've tried patience, agreement, "begging," hugging, tears, everything that I thought would work, and nothing has so far. With this patient, I'm at a loss, to say the least! He has showered one time in eight weeks. Any suggestions to enlighten me would be greatly appreciated. I've been researching for weeks now, trying to locate information.

Phyllis J., Memphis, Tennessee.

A. These behavioral issues can be very challenging. Unless he has always been this way, these behaviors are the result of his dementia and not "meanness." I recommend you read the book Learning to Speak Alzheimer's or The 36 Hour Day. These books will explain the dementia process and give you ideas on how to deal with these behaviors. If the behaviors escalate out of control and he isn't responsive to behavioral modification approaches, there are some medications that can be used as mood stabilizers that often help calm down these impulsive behaviors.

Regarding hygiene, many demented patients don't like to shower. Often the bathing experience is frightening because the water may be too hot or too cold, and they are unable to express their discomfort. Sometimes folks are afraid they may fall in the bath.  You can buy large disposable washcloths at most retail pharmacies that can be microwaved and used on the patient in a chair or in bed; they are called "bag bathes" and often work well in patients who are reluctant to shower.

This answer is provided by Dr. Vivian Argento, a trained geriatrician and member of the geriatric medical team at Bridgeport Hospital in Bridgeport, Connecticut.  Dr. Argento is an expert in memory and medical problems affecting the elderly and serves as a clinical instructor at the Yale School of Medicine at Yale University in New Haven, Connecticut. She’s also a consultant both in and out of hospitals and cares for patients in various locations, including nursing homes, assisted living facilities, and in their homes via a house calls program. Dr. Argento can be reached at pvarge@bpthosp.org.

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